Clinical significance and preventive strategies for contrast-induced nephropathy.
OBJECTIVE
Contrast-induced nephropathy continues to be a common cause of in-hospital acute kidney injury. Published studies on pathogenesis, clinical significance, diagnosis, and preventive measures have dramatically increased significantly in the past several years. This review will focus on new developments in contrast-induced nephropathy.


RESULTS
Studies on the clinical significance of contrast-induced nephropathy are reviewed along with initial reports of biomarkers in diagnosing this complication of iodinated contrast administration. Emerging literature on the relative nephrotoxicity of iso-osmolar versus low-osmolar contrast media and the value of bicarbonate hydration are discussed. More recent preventive measures using prostacyclin, 'statins', and erythropoietin are also reviewed.


CONCLUSIONS
Contrast-induced nephropathy is an increasing cause of acute kidney injury and is associated with significant mortality and morbidity. Future developments in this field will focus on refining the clinical significance of this complication, earlier diagnosis with biomarkers, clarifying the role for bicarbonate and iso-osmolar contrast agents as preventive strategies, and the introduction of new prophylactic techniques on the basis of an improved understanding of pathogenesis at the cellular level.
Sterling
Kevin A
KA
Division of Nephrology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Tehrani
Tara
T
Rudnick
Michael R
MR
D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D005440:Fluid Therapy; D006440:Hemofiltration; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D006435:Renal Dialysis; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013806:Theophylline / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017693:Sodium Bicarbonate; D013806:Theophylline; D001205:Ascorbic Acid; D000111:Acetylcysteine